Project Summary Abstract Inadequate rates of concordance with VA guidelines for antidepressant treatment among depression patients seen in primary care settings are the norm, and the problem is even more pronounced for depression patients with coexisting chronic conditions because the competing demands model suggests that co-existing conditions compete with depression for attention during primary care visits. Little is known about why the majority of patients fail to receive guideline-concordant depression care. Other research within the VA has identified barriers to effective collaboration between primary care and mental health providers to improve depression care, but this study does not address the VA's depression guidelines. None of these studies has specifically addressed a patient population with depression plus multiple chronic conditions (referred to here as "depression-MCC"). The objective of this study is to determine what facility and patient characteristics distinguish VA facilities that perform well in providing evidence-based depression care for persons with depression-MCC from VA facilities that are less successful in achieving high rates of concordance with the VA's guideline for depression care for these patients. This objective will be accomplished through the following 2 specific aims: (1) Characterize the variation in facility performance in VA depression guideline care of patients with depression-MCC by identifying patient-level characteristics associated with receipt of VA depression guideline care; and (2) Identify the effect of facility-level characteristics, controlling for patient-level characteristics, on facility-level, depression guideline performance for patients with depression- MCC. The study will apply quantitative research methods to VA administrative data and the VA Clinical Practice Organizational Survey to retrospectively assess the relationship between facility performance and patient- and facility-level characteristics. Addressing inadequate depression care is a highly relevant issue for the VA. Identifying the facility, system, and patient characteristics associated with successful performance on the VA's depression guideline could help training and education efforts for underperforming VA facilities so that the VA can increase its overall performance on providing evidence-based depression care to veterans with depression-MCC.